A New York Times bestseller/Washington Post Notable Book of 2017/NPR Best Books of 2017/Wall Street Journal Best Books of 2017
"This book will serve as the definitive guide to the past and future of health care in America.”—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies and The Gene
At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad problems.
In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast?
Breaking down this monolithic business into the individual industries—the hospitals, doctors, insurance companies, and drug manufacturers—that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw.
The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn't just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a healthcare system that no longer has our well-being at heart.
|Publisher:||Penguin Publishing Group|
|Product dimensions:||5.40(w) x 8.20(h) x 1.10(d)|
About the Author
Dr. Elisabeth Rosenthal was for twenty-two years a reporter, correspondent, and senior writer at The New York Times before becoming the editor in chief of Kaiser Health News, an independent journalism newsroom focusing on health and health policy. She holds an MD from Harvard Medical School, trained in internal medicine, and has worked as an ER physician. She lives in New York City and Washington, DC.
Table of Contents
Introduction Complaint: Unaffordable Healthcare 1
Part I History of the Present Illness and Review of Systems
1 The Age of Insurance 11
2 The Age of Hospitals 22
3 The Age of Physicians 55
4 The Age of Pharmaceuticals 87
5 The Age of Medical Devices 128
6 The Age of Testing and Ancillary Services 148
7 The Age of Contractors: Billing, Coding, Collections, and New Medical Businesses 166
8 The Age of Research and Good Works for Profit: The Perversion of a Noble Enterprise 182
9 The Age of Conglomerates 205
10 The Age of Healthcare as Pure Business 223
11 The Age of the Affordable Care Act (ACA) 230
Part II Diagnosis and Treatment: Prescriptions for Taking Back our Healthcare
12 The High Price of Patient Complacency 241
13 Doctors' Bills 248
14 Hospital Bills 261
15 Insurance Costs 280
16 Drug and Medical Device Costs 302
17 Bills for Tests and Ancillary Services 319
18 Better Healthcare in a Digital Age 321
Appendix A Pricing/Shopping Tools 343
Appendix B Tools for Vetting Hospitals 346
Appendix C Glossary for Medical Bills and Explanations of Benefits 348
Appendix D Tools to Help You Figure Out Whether a Test or a Procedure Is Really Necessary 352
Appendix E Templates for Protest Letters 354
Most Helpful Customer Reviews
Rosenthal's book is well-researched and written It is thoughtful and incredibly informative It is a powerful tool for those tangling with our healthcare system or for thosee who simply know it can be better
Excellent book with practical guides on handling your own confusing bills and great links to health care related resources. And beyond that, it's eye opening how we're all affected by this broken system from dealing with high insurance premiums to doctors being incentivized to be inefficient in order to bill more as opposed to being effective both for our health and our medical spending, and how lives are affected by bad medical devices that don't go through the right FDA approval process, etc. I've actually recently seen some billing issues she described, and was inspired to request the itemized bill as well as to use the reference she provides to compare the bill to relevant fair prices.
An insider’s view on elaborate fee outlays, insurance perversions and how our medical system has turned its primary focus from patient care to making the most money possible. It is illuminating, alarming, nonpartisan and pragmatic for patients. The World Health Organization says the U.S. is 40th in the world in overall quality of care… yet Americans are forced to spend more on heath care per capita than any other nation on earth… by far. What is driving up costs? Rosenthal gives a few examples: in 1986 a statue was passed that said all patients who arrived at a hospital's ER had to be treated. But since highly-paid specialists are not required to treat the patients, the hospitals are in a quandary. Therefore, the specialists get to bill whatever they choose. Most European countries regulate drug and medical procedure pricing, but not the U.S. And, incredibly, the U.S. is one of only 2 countries that allow prescription drug advertising!! Medical coding and coders like in the U.S. "essentially don't exist in any other health care system." Having highly skilled codes means another middle man and higher health care bills. Another doozy from the health care book: in 2015, the medical industry spent almost a half a billion dollars on lobbying. The oil and gas industry spent $130 million, investment firms $100 million, defense/aerospace $75 million. By 2014, 52% of overdue debt on credit cards was due to medical bills. National studies have estimated that one-third of all medical procedures are unnecessary. Etc. Rosenthal introduces a 10 Commandments-type list that summarizes the new health care landscape – like “Always recommend the most expensive option to the patient” and “A lifetime of charges is better than a cure.” But there are 18 chapters with a lot of statistics. It might have been better to dedicate a chapter to each of the 10 rules to assist the reader in remembering more of the book. Half of An American Sickness is about solutions. The easiest and most far reaching is for patients to demand price transparency. Your doctor or office should know the price for everything, should be well aware of cheaper options, up front. Most doctors are honest and sharp. Patients only have to deal with the bureaucracy and high prices when we get sick - doctors deal with the difficulties all the time. Rosenthal gives you great tools at the end, like Healthcarebluebook.com, which calculates a fair price on a large number of procedures that you can use to bargain prices downward. Politically, she recommends some obvious, free-market solutions – the government should be able to bargain for bulk drug prices for pharmaceutical drugs for Medicare and Medicaid, and we should be able to travel to and import drugs from other countries if they are of the same quality. This would also drive down prices and give more care options to Americans. A quick, powerful read with ideas anyone could use right away and for the longer haul towards vitally needed changes.